Attachment_A_AF_3065_Breakout_Divisions.xls

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&L&"Arial,Bold"AF FORM 3065, 19960401 (EF-V3)&C&8PREVIOUS EDITION IS OBSOLETE&R

Atch 6 OMA No. 9000-0068 Expires Apr 30, 1999 Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing date sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestion for reducing this burden to the Department of Defense, Washington Headquarters Services, Directorate for Information Operations and reports (OMB No. 9000-0058), 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. RETURN COMPLETED FORM TO: SAF/AQCO, 1060 Air Force Pentagon, Washington DC 20330-1060

CONTRACTOR

ADDRESS

REPORT NO.

PERIOD COVERED

PROJECT NO.

CONTACT NO.

COMPLETION DATE

LINE NO.

Cost

WORK ELEMENT

DATE

SIGNATURE

TYPE OR PRINT NAME AND TITLE

REVIEWED BY OR FOR CONTRACTING OFFICER

DATE

SIGNATURE

TYPE OR PRINT NAME AND TITLE

SUBMITTED BY OR FOR

BASE CIVIL ENGINEER

PROGRESS OR COMPLETION CERTIFICATE

I hereby certify that the contractor has completed the indicated percentage of the contract per contract specifications.

At the Contracting Officer's discretion and according to the payments clause of the contract, the information provided on this form may be used for computing progress payments.

REMARKS

TOTAL

CONTRACTOR

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